Menopause Flashcards
menopause occurs with
1000
Changes with estrogen loss
increase ldl decrease hdl bone loss CNS- hot flashes nightsweats memory GI- decreased motility CV- vasodilation atherosclerosis GU- loss support vaginal vault
Perimenopause occurs \_\_\_\_ estrogen levels\_\_\_\_ biggest complaint\_\_\_\_ duration \_\_\_\_\_
occurs in 40s
estrogen levels rise/fall- unstable
biggest c/o menstrual irregularity
2-8 years (avg. of 5)
undergo menopause at earlier age
smokers type I dm increased altitude undernourished/vegetarian NO LINK to FH cancer hysterectomy
what does progesterone do to uterus?
keeps it thin
women c/o skipping period and when it comes its heavy..what do you do?
biopsy
then progesterone only
progesterone iud
combo prog/estrog
women c/o nightsweats, moody irritable, light periods…what do you do?
SSRI: prozac, effexor
combo prog/estro
menopause end of \_\_\_\_\_\_\_ cessation of menses for \_\_\_\_\_ surgical removal of \_\_\_\_\_\_ age \_\_\_\_\_\_
end of reproductive life
cessation of menses for 1 year
surgical removal of ovaries
age 50
menopause etiology results from changes in \_\_\_\_\_ atresia of \_\_\_\_\_\_ fewer follicles decreased production of \_\_\_\_\_ (most potent) then \_\_\_\_\_ becomes primary E2 from \_\_\_\_\_
results from changes in ovaries
atresia of follicles
fewer follicles, decreased production of estradiol (most potent) E2
estrone becomes primary (from adipose tissue)
Lab tests
FSH >______ indicates menopause
Estradiol
FSH>40
Estradiol
menopause tx begins with
education
Hormone replacement therapy
Used for ________ menopause
Must be used in women with _________
used for symptomatic menopause
must be used in women with an intact uterus
Estrogen replacement therapy for women with_____
estrogen replacement therapy for women with hysterectomy
hrt forms
estrog/prog cyclic or continuous
(estrogen qd and prog 10 days)
continuous is better
Benefit of HRT
dec. flashes
improve genitourinary
dec. osteoporosis and cardiac (1st year inc.)
?dementia
Contraindications for HRT
undx vaginal bleeding pregnancy hx thromboembolic episodes liver disease cancer breast resp tract
HRT precaution
type 1 dm gallbladder disease >1ppd obesity/elevated trig fmh breast ca fibroid uterus (stimulated by estrogen) hx peripheral vascular migraines
HRT candidate
menopause within 5 years good health no risk factors heart or breast (no first degree relative) nonsmoker nonobese normal bs and bp mod-sev sx
HRT risks
blood clots
gall bladder disease
breast cancer
cardiac in 1st year if prior heart disease
Breast cancer risk with HRT
10 increased risk
estrogen alone can be used for
7 years
estrogen progesterone can be used for
5 years
estrogen replacement therapy drug options
premarin
menest
estradiol
transdermal (best- avoids liver, less trig and lipid)
HRT drug options
provera or prometrium
combined: prempro, premphase, femHRT, activella, ortho-prefest, combipatch
duavee- estrogen with bazedoxifene ( reduce effect of estrogen on uterus)
SE HRT
BTB (if continues over a year then eval)
Fibroids
Allergic
Virilization (testosterone products)
Progesterone: breast tenderness, fluid retention, weight gain, depression, irritability
Sleep options
melatonin
gabapentin
lunesta
Vasomotor pharmacology
brisdelle (paroxetine) effexor gabapentin clonidine SSRI: paxil, prozac, zoloft
In 5-7 years following menopause a women will lose up to ______ of bone density
20%
Osteoporosis risk factors
history fx >50 low E2 women caucasian thin
Bone density scan should be done on….
>65 fh small frame smoker, etoh, glucocorticoid postmenopausal not on hrt low activity early menopause hx rib, hip, forearm, vertebral fx
USPSTF osteoporosis screening recommendation
65+ or 60 if increased risk
Dexa screening
____ x ray
measures __,___,___
dual energy x ray
hip spine wrist
BMD scores and retesting
- 1 normal: 10-15 years
- 1 to -2.5 osteopenia: 2-5 years
- 2.5 osteoporosis: every year
Frax test what it shows
BMD + predicts risk of breaking bone in 10 years
BMD results and treatment
Normal
Low bone density
Osteoporosis
normal: ca and vit d healthy diet exercise
low bd: same + fosamax 1/2 strength
osteoporosis: same+ full strength + refer to endocrinology
Calcium and vitamin d requirement
men?
over 65?
1200 mg whether HRT or not
400-800 vitamin D
men: 1000 mg
over 65: 1500 mg
2 classes of osteoporosis meds and what their goals are
antiresorptive (biphosphonates): slow bone loss
anabolic parathyroid hormone: build bone
biphosphonates dec risk of fracture by _____ over _____
50% over 2-4 years
How to take biphosphonates
1st thing in the morning on an empty stomach with glass of water
30 mins before eating drinking
stay upright
Boniva aka ____ is a ____ and is rx by ______ it is an __________
boniva aka ibandronate is a biphosphate rx by endocrine, it is an IV medication (or oral)
risedronate aka
actonel atelvia
zoledronic acid aka
prevention and treatment of
reclast
prevention and tx of steroid induced osteoporosis
SE biphosphonates
bone, joint, muscle pain nausea, heartburn uveitis ONJ- jaw necrosis spontaneous fx of femurs: >5 years drug holiday
parathyroid hormone drugs for osteoporosis
teriparatide or forteo
denosunmab or prolia
injections
SERM aka is a \_\_\_\_\_ decreases \_\_\_\_\_\_ and \_\_\_\_\_ increases \_\_\_\_ contraindications: SE: \+ effect on \_\_\_\_, no risk of \_\_\_\_\_\_\_
reloxifene or evista is an estrogen modulator decreases bone turnover and resorption increases bone density contraindications: thromboembolic risk DVT in first 4 months SE: leg cramps, hot flashes \+ effect chol, no risk breast/uterus
Calcitonin is for \_\_\_\_ for women >\_\_\_\_\_ suppresses \_\_\_\_\_\_ form\_\_\_\_\_ alternate\_\_\_\_ contraindications\_\_\_\_ SE:
spine > 5 years postmenopausal suppresses osteoclast activity form nasal spray alternate nostrils contraindications: allergy or salmon SE: rhinitis, arthralgia, back pain, HA, epistaxis
Interstitial cystitis aka
absence of ____
coexists with
what worsens symptoms??
bladder pain syndrome
absence of other etiology
coexcists with fibromyalgia, ibs
worsen sx: caffeine, etoh, fruit, tomato, spicy food
Sx interstitial cystitis
discomfort full relief with voiding urgency, frequency, nocturia pelvic tenderness pain with sex *urinary incontinence not a symptom gradual onset, >6 months
Causes interstitial cystitis
unknown ?mast cell- inflammatory, histamine urine changes in nerves immune system
Findings in interstitial cystitis
tenderness lower abdomen
negative: urine, chlamydia, cystoscopy
dx: postvoid residual urine volume to r/o obstruction
Tx interstitial cystitis
Antihistamines (atarax, claritin) TCA (imipramine, amitriptylline) Pentosan (urology) Anti-inflammatories (advil) Urology for infusions (heprain, dimethyl sulfoxide)
Overactive bladder def. and char.
muscles of bladder contrx involuntarily
urgency
incontinence (maybe)
frequency, nocturia (usually)
Risk fx for overactive bladder
Neurological High urine prod (diabetes, kidney disease) Medications UTI Bladder tumor/stone Outflow obstruction (prostate, constipation) Caffeine/ETOH Cognitive decline Ambulating Constipation Incomplete emptying
Tx overactive bladder
Fluid restrx Avoid caffeine Pelvic floor exercises Medications: antimuscarinic Oxybutynin (ditropan) Tolterodine (detrol) caution glaucoma (dry eyes, constipation)
